Effect of cervical length on the induction of labor in postterm pregnancy

Year 2023, Volume: 48 Issue: 2, 344 - 350, 02.07.2023

Cenk Soysal , Mehmet Murat Işıkalan

https://doi.org/10.17826/cumj.1239080

Abstract

Purpose: This study aims to investigate the effect of cervical length measured before induction of labor on the duration of labor and oxytocin dose administered for induction during labor in post-term pregnant women.
Materials and Methods: Eighty-seven post-term pregnant women were included in this prospective study. Cervical length was measured before the induction of labor with oxytocin. The relationship between cervical length and the time until delivery and total oxytocin dose parameters were examined. The effect of confounder factors was determined by logistic regression analysis.
Results: Sixty-five (74.71%) of the patients gave birth by normal vaginal delivery and 22 (25.29%) by cesarean section. It was found that parity, bishop score, cervical length and fetal weight variables predicted oxytocin dose by 67% (R-square = 0.675). Patients with a cervical length of >32mm measured before induction were more likely to have a cesarean section than those with a cervix shorter than 32 mm (OR:3.7). Parity had the greatest effect among these variables (β = -.40, p <.001).
Conclusion: Cervical length is a useful marker in predicting the success of labor induction with oxytocin in post-term pregnant women. The total oxytocin dose used in labor induction is related to cervical length.

Keywords

Cervical length, postterm pregnancy, transvaginal ultrasound

Servikal uzunluğun postterm gebelikte doğum indüksiyonuna etkisi

Abstract

Amaç: Çalışmanın amacı postterm gebelerde doğum indüksiyonu öncesi ölçülen servikal uzunluğun, doğum zamanına ve travay boyunca indüksiyon için verilen oksitosin dozuna olan etkisini araştırmaktır.
Gereç ve Yöntem: Prospektif olarak yapılan bu çalışmaya postterm 87 gebe dahil edilmiştir. Gebelere oksitosin ile doğum indüksiyonu öncesinde servikal uzunluk ölçümü yapılmıştır. Servikal uzunluğun doğuma kadar geçen süre, toplam oksitosin dozu parametreleri ile ilişkisi incelenmiştir. Konfonder faktörlerin etkisi logistik regression analizi ile belirlenmiştir.
Bulgular: Hastaların 65’i (%74.71) normal vajinal yolla, 22’si (%25.29) sezaryen ile doğum yapmıştır. Parite, Bishop skoru, servikal uzunluk ve fetal ağırlık değişkenleri oksitosin dozunu %67 oranında predikte ettiği saptandı (R-square = 0.675). İndüksiyon öncesi ölçülen servikal uzunluğu >32 mm olan hastaların, serviksi 32 mm’den kısa olanlara göre sezaryen olma olasılığı daha yüksek olarak saptandı (OR:3.7). Bu değişkenlerden en büyük etkiyi parite göstermekteydi (β = -.40, p <.001).
Sonuç: Servikal uzunluk; doğum eylemi indüksiyonu, toplam oksitosin dozu ve doğum süresi için iyi bir ultrasonografik belirleyicidir. Klinik uygulamalarda yaygın kullanılmamasına rağmen zaman geçtikçe indüksiyon başarısı açısından kullanımı yaygınlaşacaktır.

Keywords

Doğum indüksiyonu, postterm gebelik, servikal uzunluk, transvajinal ultrason

References

• Caughey AB, Snegovskikh VV, Norwitz ER. Postterm pregnancy: how can we improve outcomes? Obstet Gynecol Surv. 2008;63:715-24.
• Vayssiere C, Haumonte J-B, Chantry A, Coatleven F, Debord MP, Gomez C et al. Prolonged and post-term pregnancies: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol. 2013;169:10-6.
• Caughey AB, Stotland NE, Washington AE, Escobar GJ. Maternal and obstetric complications of pregnancy are associated with increasing gestational age at term. Am J Obstet Gynecol. 2007;196:155-16.
• Graves BW, DeJoy SA, Heath A, Pekow P. Maternal body mass index, delivery route, and induction of labor in a midwifery caseload. J Midwifery Womens Health. 2006;51:254-9.
• Obstetricians ACo, Gynecologists. Practice bulletin no. 146: Management of late-term and postterm pregnancies. Obstet Gynecol. 2014;124:390.
• National Institute for Health and Care Excellence (NICE). Caesarean section England, UK2019 [Available from: https://www.nice.org.uk/guidance/cg132.
• Harper LM, Caughey AB, Odibo AO, Roehl KA, Zhao Q, Cahill AG. Normal progress of induced labor. Obstet Gynecol. 2012;119:1113-8.
• Bennett KA, Crane JM, O'shea P, Lacelle J, Hutchens D, Copel JA. First trimester ultrasound screening is effective in reducing postterm labor induction rates: a randomized controlled trial. Am J Obstet Gynecol. 2004;190:1077-81.
• Kaufman KE, Bailit JL, Grobman W. Elective induction: an analysis of economic and health consequences. Am J Obstet Gynecol. 2002;187:858-63.
• EH. B. Pelvic scoring for elective induction. Obstet Gynecol. 1964;24:8.
• Obstetricians ACo, Gynecologists. ACOG practice bulletin no. 127: Management of preterm labor. Obstet Gynecol. 2012;119:1308.
• Owen J, Yost N, Berghella V, MacPherson C, Swain M, Dildy III GA et al. Can shortened midtrimester cervical length predict very early spontaneous preterm birth? Am J Obstet Gynecol. 2004;191:298-303.
• Banu S, Jaysahree V, Latha K. Study of comparison of transvaginal cervical length and modified Bishop’s score in predicting the mode of delivery at term following induction of labor. J Obstet Gynaecol India. 2016;4:134-40.
• ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol. 2009;114:386-97.
• Carlhäll S, Källén K, Blomberg M. The effect of maternal body mass index on duration of induced labor. Acta Obstet Gynecol Scand. 2020;99:669-78.
• Mogren I, Lindqvist M, Petersson K, Nilses C, Small R, Granåsen G et al. Maternal height and risk of caesarean section in singleton births in Sweden-A population-based study using data from the Swedish Pregnancy Register 2011 to 2016. PloS one. 2018;13:e0198124.
• de Vries B, Narayan R, McGeechan K, Santiagu S, Vairavan R, Burke M et al. Is sonographically measured cervical length at 37 weeks of gestation associated with intrapartum cesarean section? A prospective cohort study. Acta Obstet Gynecol Scand. 2018;97:668-76.
• Tan P, Vallikkannu N, Suguna S, Quek K, Hassan J. Transvaginal sonographic measurement of cervical length vs. Bishop score in labor induction at term: tolerability and prediction of Cesarean delivery. Ultrasound Obstet Gynecol. 2007;29:568-73.
• Ezebialu IU, Eke AC, Eleje GU, Nwachukwu CE. Methods for assessing pre‐induction cervical ripening. Cochrane Database Syst Rev. 2015.
• Gokturk U, Cavkaytar S, Danısman N. Can measurement of cervical length, fetal head position and posterior cervical angle be an alternative method to Bishop score in the prediction of successful labor induction? J Matern Fetal Neonatal Med. 2015;28:1360-5.
• Akay NÖ, Hızlı D, Yılmaz SS, Yalvaç S, Kandemir Ö. Comparison of low-dose oxytocin and dinoprostone for labor induction in postterm pregnancies: a randomized controlled prospective study. Gynecol Obstet Invest. 2012;73:242-7.
• Cubal A, Carvalho J, Ferreira MJ, Rodrigues G, Carmo OD. Value of Bishop score and ultrasound cervical length measurement in the prediction of cesarean delivery. J Obstet Gynaecol Res. 2013;39:1391-6.
• Sevrin CE, Martorelli LM, Famá EAB, Fernandes CE, Sancovski M, Oliveira E. Ultrasound Evaluation of the Cervix to Predict Failed Labor Induction. Rev Bras Ginecol Obstet. 2019;41:476-84.
• Papillon-Smith J, Abenhaim HA. The role of sonographic cervical length in labor induction at term. J Clin Ultrasound. 2015;43:7-16.
• Stang J, Huffman LG. Position of the Academy of Nutrition and Dietetics: Obesity, reproduction, and pregnancy outcomes. J Acad Nutr Diet. 2016;116:677-91.
• Wolfe KB, Rossi RA, Warshak CR. The effect of maternal obesity on the rate of failed induction of labor. Am J Obstet Gynecol. 2011;205:128.e1-7.
• Maged AM, El-Semary AM, Marie HM, Belal DS, Hany A, Taymour MA et al. Effect of maternal obesity on labor induction in postdate pregnancy. Arch Gynecol Obstet. 2018;298:45-50.